| (III) except in a small facility, when an observer
who is trained to identify risks associated with positional, compression,
or restraint asphyxiation and with prone and supine holds is ensuring
that the resident's breathing is not impaired.
(F) A facility must release a resident from a restraint:
(i) as soon as the resident no longer poses a risk
of imminent physical harm to the resident or others; or
(ii) if the resident in restraint experiences a medical
emergency, as soon as possible as indicated by the medical emergency.
(G) If a facility restrains a resident as provided
in subparagraph (B)(i) of this paragraph, the facility must obtain
a written order authorizing the restraint from a health care professional
acting within his or her scope of practice by the end of the first
business day after the use of a restraint.
(H) A facility must ensure that each resident and the
resident's legally authorized representative (LAR) are notified of
HHSC rules and the facility's policies related to restraint and seclusion.
(I) A facility may adopt policies that allow less use
of restraint than allowed by the rules of this chapter.
(5) Pharmacy services.
(A) All pharmacy services must comply with the Texas
State Board of Pharmacy requirements, the Texas Pharmacy Act, and
rules adopted thereunder, the Texas Controlled Substances Act, and
Texas Health and Safety Code, Chapter 483 (relating to Dangerous Drugs).
(B) All medications must be ordered orally or in writing
by a health care professional acting within the scope of his or her
practice. Oral orders may be taken only by a licensed nurse, a pharmacist,
physician assistant, or physician, and must be immediately transcribed
and signed by the individual taking the order. Oral orders must be
signed by the health care professional who ordered the medication
within seven working days after issuing the order.
(C) A facility, with input from the consultant pharmacist
and a health care professional acting within the scope of his or her
practice, must develop and implement procedures regarding automatic
stop orders for medications. These procedures must be utilized when
the order for a medication does not specify the number of doses to
be given or the time for discontinuance or re-order.
(6) Specialized nutrition support (delivery of parenteral
nutrients and enteral feedings by nasogastric, gastrostomy, or jejunostomy
tubes) must be given:
(A) by a health care professional acting within the
scope of his or her practice or by a person to whom a health care
professional has properly delegated performance of the task; and
(B) in accordance with an order issued by a health
care professional acting within the scope of his or her practice.
(7) Self-administration of medication and emergency
medication kits.
(A) A resident who has demonstrated the competency
for self-administration of medication must have access to and maintain
his or her own medication. The resident must have an individual storage
space that permits him or her to store the medication under lock and
key.
(B) A resident may participate in a self-administration
of medication training program if the IDT determines that self-administration
of medication is an appropriate objective. A resident participating
in a self-administration of medication training program must have
training in coordination with and as part of the resident's total
active treatment program. The resident's training plan must be evaluated
as necessary by a licensed nurse. The supervision and implementation
of a self-administration of medication training program may be conducted
by staff described in §551.43(a)(1), (3), and (4) of this subchapter
(relating to Administration of Medication).
(C) A facility may maintain a supply of controlled
substances in an emergency medication kit for a resident's emergency
medication needs, as outlined under §551.324 and §551.325
of this chapter (relating to Emergency Medication Kit and Controlled
Substances).
(8) Infection prevention and control.
(A) A facility must establish, implement, enforce,
and maintain an infection prevention and control policy and procedure
designated to provide a safe, sanitary, and comfortable environment
and to help prevent the development and transmission of disease and
infection.
(B) A facility must comply with rules regarding special
waste in 25 TAC Chapter 1, Subchapter K (relating to Definition, Treatment,
and Disposition of Special Waste from Health-Care Related Facilities).
(C) A facility must immediately report the name of
any resident of a facility with a reportable disease, as specified
in 25 TAC Chapter 97, Subchapter A (relating to Control of Communicable
Diseases) to the city health officer, county health officer, or health
unit director having jurisdiction, and implement appropriate infection
control procedures as directed by the local health authority.
(D) A facility must have, implement, enforce, and maintain
written policies for the control of communicable disease among employees
and residents, which must address tuberculosis (TB) screening and
the provision of a safe and sanitary environment for residents and
employees.
(i) If an employee contracts a communicable disease
that is transmissible to residents through food handling or direct
resident care, the facility must exclude the employee from providing
these services for the applicable period of communicability.
(ii) A facility must maintain evidence of compliance
with local and state health codes or ordinances regarding employee
and resident health status.
(iii) A facility must screen all employees for TB within
two weeks of employment and annually, according to the Centers for
Disease Control and Prevention (CDC) screening guidelines. A person
who provides services under an outside resource contract must, upon
request of the facility, provide evidence of compliance with this
requirement.
(iv) A facility's policies and practices for resident
TB screening must ensure compliance with the recommendations of a
resident's attending physician and consistency with CDC guidelines.
(E) A facility's infection prevention and control program
established under subparagraph (A) of this subsection must include
written policies and procedures for:
(i) monitoring of key infectious agents, including
multidrug-resistant organisms, as those terms are defined in §551.3
of this chapter (relating to Definitions);
(ii) wearing personal protective equipment, such as
gloves, a gown, or a mask based on anticipated exposure, and properly
cleaning hands before and after touching another resident;
(iii) cleaning and disinfecting environmental surfaces,
including doorknobs, handrails, light switches, and handheld electronic
control devices;
(iv) using universal precautions for blood and bodily
fluids; and
(v) removing soiled items (such as used tissues, wound
dressings, adult briefs, and soiled linens) from the environment at
least once daily, or more often if an infection or infectious disease
is present or suspected.
(F) A facility must establish, implement, enforce,
and maintain written policies and procedures for making a rapid influenza
diagnostic test, as defined in §551.3 of this chapter (relating
to Definitions), available to a resident who is exhibiting flu-like
symptoms.
(G) Staff must handle, store, process, and transport
linens to prevent the spread of infection.
(H) A facility must use universal precautions in the
care of all residents.
(9) Water activities. A facility must ensure the safety
of all residents who participate in facility-sponsored events. For
this section, a water activity is defined as an activity which occurs
in or on water that is knee deep or deeper on the majority of residents
participating in the event. To ensure the safety of all individuals
who participate, the requirements in subparagraphs (A) - (F) of this
paragraph apply.
(A) A facility must develop a policy statement regarding
the water sites utilized by the facility. Water sites include lakes,
amusement parks, and pools.
(B) A minimum of one staff person, who is certified
and has demonstrated proficiency in CPR must be on duty and at the
site when residents are involved in water activities.
(C) A minimum of one person with demonstrated proficiency
in water life-saving skills must be on duty and at the site when activities
take place in or on water that is deep enough to require swimming
for life-saving retrieval. This person must maintain supervision of
the activity for its duration.
(D) A sufficient number of staff or a combination of
staff and volunteers must be available to meet the safety requirements
of the group and specific residents.
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